Table 3 Summary of selected studies

Bell, Pascucci, Fancy, Coleman, Zurakowski and Meyer [24]

Mixed methods

Health professionals from four disciplines (n = 192)

Use of improvisational actors in difficult conversations to teach communication and relational skills to practicing health professional

Non-directed role: no use of observational tool or verbal guidance reported

No difference between observers and hands on learners in: perceived realism; usefulness of actors; usefulness of scenarios; and, opinions on non-actor role play

Post-simulation survey design with qualitative and quantitative analysis

Teaching faculty (n = 33)

Convenience sample

Actors (SP) (n = 10)

Hands on participants (47 %)

Observers (53 %)

Harder, Ross and Paul [25]

Ethnographic stud

Bachelor of Nursing students year 3 (n = 84)

Role assignment within regular simulation session with analysis of experience and perceptions of learning within different role

Non-directed role: no use of observer tool or verbal guidance reported

Students preferred assignment to nursing roles rather than observer or non nursing role

Observational design with focused interview and journal review of selected participants

Participant/observation (n = 84) interview (n = 12)

All participants experienced both roles

Structured role descriptions positively affected learning outcomes

Volunteer sample

journal review (n = 4)

Hober and Bonnel [11]

Qualitative

Bachelor of Nursing “senior” students (n = 50)

Immersive simulation scenarios with students randomly assigned to active or observer roles

Directed observer role: observer tool – educator provided activity guidelines

Observer role beneficial, less stressful

Survey and interview design

Observers (n = 23)

All completed survey

Use of a guided observer tool useful

Convenience sample

hands on learners (n = 27)

Observers interviewed

Able to reflect in action and on action

Kaplan, Abraham and Gary [27]

Quantitative

Bachelor of Nursing “junior” students (n = 92)

Immersive simulation scenarios -

Directed observer role: observer tool -checklist

No difference in knowledge

Randomised groups

Observers (n = 46)

participants self selected roles

Convenience sample

Scenario participants (n = 46)

Unclear whether observers self selected or were assigned

Limited as aggregated post satisfaction survey data

Post scenario knowledge test and satisfaction survey

Lau, Stewart and Fielding [22]

Quasi experimental randomised to roles

Medical students (bilingual) year 1 (n = 160)

Student role plays with comparison of learning between interpreter role play and observer role

Directed observer role: observer tool -checklist

Observers rated post knowledge higher than learners in interpreter role-play

Convenience sample

Self rated pre & post knowledge

Smith, Klaassen, Zimmerman and Cheng [26]

Mixed methods with increasing variables over three years

Bachelor of Nursing “junior” students

Introduction of simulation year 1

Non-directed role: no use of observational tool or verbal guidance reported

No significant difference in learning outcomes, student perceptions or peer evaluations

Introduction non nursing participatory roles year

Convenience sample

year 1 (n = 67)

Introduction non participatory observer roles year 3

year 2 (n = 72)

year 3 (n = 85)

Note only the year 2 and 3 data were included in review

Stegmann, Pilz, Siebeck and Fischer [20]

Quantitative

Medical students (n = 200)

Comparison of participatory role and observer role in simulated patient scenario with and without observation tool

Non-directed and directed observer roles compared: checklists and feedback scripts used

Observational learning (especially if supported by observer script) more effective than learning by doing

Crossover design 2x2x2 pre-test post-test

Stiefel, Bourquin, Layat, Vadot, Bonvin and Berney [23]

Quantitative

Medical students (masters level) (n = 124)

Individual training with simulated patient encounter

Non-directed role: no use of observer tool or verbal guidance reported

Measured outcomes no difference

Randomised into 2 group

Individual training (n = 49) Group training (n = 75) -participated in simulation (n = 14) observed (n = 61)

Group training with simulated patient encounter

Those who observed but did not participate felt they did not meet their learning objectives as well compared to the other 2 groups

Evaluation using instructor rating scale and student questionnaire

Group training with observation of simulated encounter

Convenience sample

Thidemann and Soderhamn [21]

Quasi experimental

Bachelor of Nursing student year 2 (n = 144)

Immersive mannequin simulation with random allocation to groups

Directed observer role: observer tool with specific task focus

Post-test scores higher in all groups independent of rol

Pre - and post-simulation knowledge test and student questionnaire

Four volunteers within each group allocated to participatory and in scenario observer roles – remainder observers (n = 72)

More satisfaction with nurse role

Convenience sample over two consecutive years